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### Question: How to know you have 5-alpha-reductase deficiency?
### Response: Testosterone -to- dihydrotestosterone (T/DHT) level: In patients with 5-alpha-reductase deficiency, the testosterone level is normal or modestly elevated, whereas the DHT level is much low. Then, testosterone-to-dihydrotestosterone (T/DHT) level may be increased. Mutation analysis of the 5-alpha-reductase type 2 gene: It is primarily a research tool and not commercially available at present. Urinary ratios of various metabolites: These are also not commercially available currently. Pelvis ultrasonography: This is an painless test which uses sound waves to create a picture of the internal organs. For patients with 5-alpha-reductase deficiency, pelvis ultrasonography may be for differential diagnosis. Vaginogram: In patients with 5-alpha-reductase deficiency, vaginogram may be used to measure vaginal length and show no fistulous connections between the urinary tract and vagina.